Kenneth Hao Form 4 Broadcom / Kenneth Hao ownership change

SEC Form 4

FORM 4

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940

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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

1. Name and Address of Reporting Person^*

Hao Kenneth

(Last) (First) (Middle)

C/O SILVER LAKE PARTNERS

2775 SAND HILL ROAD, SUITE 100

(Street)

MENLO PARK CA 94025

(City) (State) (Zip)

2. Issuer Name and Ticker or Trading Symbol
Broadcom Inc. [ AVGO ]

5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

X	Director	10% Owner
	Officer (give title below)	Other (specify below)

3. Date of Earliest Transaction (Month/Day/Year)
04/04/2018

4. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3)	2. Transaction Date (Month/Day/Year)	2A. Deemed Execution Date, if any (Month/Day/Year)	3. Transaction Code (Instr. 8)		4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5)			5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)	6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	7. Nature of Indirect Beneficial Ownership (Instr. 4)
			Code	V	Amount	(A) or (D)	Price
Common Stock, $0.001 par value	04/04/2018		A(1)		807	A	$0.00	76,096	I	See footnote(2)
Common Stock, $0.001 par value								1,587,737	I	Held through SLP Argo I Ltd.(3)
Common Stock, $0.001 par value								30,830	I	Held through SLP Argo II Ltd.(4)
Common Stock, $0.001 par value								9,854	I	See footnote(5)
Common Stock, $0.001 par value								18	I	See footnote(6)

Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3)	2. Conversion or Exercise Price of Derivative Security	3. Transaction Date (Month/Day/Year)	3A. Deemed Execution Date, if any (Month/Day/Year)	4. Transaction Code (Instr. 8)		5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)		6. Date Exercisable and Expiration Date (Month/Day/Year)		7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4)		8. Price of Derivative Security (Instr. 5)	9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)	10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	11. Nature of Indirect Beneficial Ownership (Instr. 4)
				Code	V	(A)	(D)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares

Explanation of Responses:

1. Represents a grant of restricted stock units which, subject to Mr. Hao's continued service as a member of the board of directors through the vesting date, will vest in full on the earlier of April 4, 2019 or the date on which the annual meeting of the Issuer shareholders immediately following the vesting commencement date is held.

2. These securities are held by Mr. Hao for the benefit of certain entities affiliated with Silver Lake (Offshore) AIV GP IV, Ltd. ("AIV GP IV") ("Silver Lake"). Mr. Hao serves as a director of the Issuer. Pursuant to Mr. Hao's arrangement with Silver Lake with respect to director compensation, upon the sale of these securities, the proceeds from such sale(s) are expected to be remitted to Silver Lake and/or its limited partners. Mr. Hao, through his role at Silver Lake and its affiliates, may be deemed to have an indirect interest in these securities. Mr. Hao is a director of AIV GP IV.

3. These securities are directly held by SLP Argo I Ltd. ("Argo I"). Mr. Hao, as a director of Argo I and AIV GP IV, the sole general partner of Silver Lake Technology Associates IV Cayman, L.P. ("SLTA IV Cayman"), the sole general partner of Silver Lake Partners IV Cayman (AIV II), L.P., the sole shareholder of Argo I, may be deemed to be an indirect beneficial owner of the securities directly owned by Argo I.

4. These securities are directly held by SLP Argo II Ltd. ("Argo II"). Mr. Hao, as a director of Argo II and AIV GP IV, the sole general partner of SLTA IV Cayman, the sole general partner of Silver Lake Technology Investors IV Cayman, L.P., the sole shareholder of Argo II, may be deemed to be an indirect beneficial owner of the securities directly owned by Argo II.

5. These securities are held by Hao Family Trust u/a/d 10/12/99.

6. These securities are held by Mr. Hao's family limited partnership.

Remarks:

On April 4, 2018, Broadcom Inc., a Delaware corporation, became the successor of Broadcom Limited, a company organized under the laws of the Republic of Singapore ("Broadcom Limited"), pursuant to a scheme of arrangement under Singapore law under which all issued ordinary shares in the capital of Broadcom Limited were exchanged on a one-for-one basis for shares of common stock of Broadcom Inc. (the "Redomiciliation"). The Redomiciliation had the effect of changing Broadcom Limited's domicile, but did not alter the proportionate interests of shareholders. Pursuant to Rule 16a-1(a)(4) of the Exchange Act, this filing shall not be deemed an admission that the Reporting Person is a beneficial owner of all securities covered by this filing, and the Reporting Person disclaims beneficial ownership of these securities, except to the extent of his pecuniary interest therein, if any.

	/s/ Kenneth Y. Hao	04/06/2018
	** Signature of Reporting Person	Date
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